Julie Daltrey – Nurse Practitioner (Older Adult)

For Julie Daltrey a “big year” has culminated in her appointment last week as nurse practitioner (older adult) at Waikato District Health Board, with an additional role as honorary professional teaching fellow at University of Auckland. The latter role sees her support the training of new nurse practitioners starting with the 2016 intake.

Julie was the recipient of a New Zealand Nurses Organisation (NZNO) services to nursing award in mid-September, with NZNO president Marion Guy describing her as “an exemplary role model who has made a significant contribution to gerontology nursing at a local and national level.” She was on the NZNO Gerontology Section from 2010 to 2014 (chair from 2012-2014) and convenor of two of its bi-annual conferences, and instrumental in moving the section towards College status. Gerontology is the health of older people.

None of this year’s achievements come out of the blue. They are based on many years’ work fuelled by her passion for the health and wellbeing of older people and for making a difference.

Julie’s previous role with Waikato DHB as a clinical nurse specialist (CNS) in gerontology laid an important foundation of practical knowledge and skills. This was aided by the arrival of Professor Matthew Parsons as Professor of Gerontology Nursing at Waikato DHB. One of the research projects initiated by Professor Parsons was to evaluate the impact on improving quality in residential aged care by having a clinical nurse specialist available. Julie became that community-based nurse specialist as part of the research project. She later took a clinical nurse specialist inpatient role in Older Persons and Rehabilitation to get further clinical experience.

“The research result showed a trend for improvement in quality, and at the same time the project role gave me an opportunity to gain more clinical practice and confidence in my practice.

“It also made me realise I wanted to take it a step further and be a nurse practitioner.”

By that time Julie had completed her Masters degree and prescribing qualifications, which are two requirements of a nurse practitioner. When the chance came to complete a nurse practitioner internship with Dr Michal Boyd, herself a nurse practitioner and also senior lecturer in gerontology at the University of Auckland, Julie moved under the wing of Waikato DHB’s Rural and Community Services which enabled her to take advantage of the once-in-a-lifetime opportunity.

It took Julie only 12 months to achieve nurse practitioner status, during which time she received medical mentorship from two GPs – Dr Rawiri Keenan and Dr Mohammad Bhar of Third Age Health (a primary healthcare provider) in Radius Care residential aged care facilities.

Julie submitted her portfolio and was awarded nurse practitioner status in April this year.

Julie describes the transition to nurse practitioner as “enormously satisfying”.

“As a nurse practitioner you bring your nursing perspective to a patient, but you have the ability to do much more in terms of clinical assessment, diagnosis, ordering and interpreting tests, prescribing, treating, and also following up patients.

“You are using a combination of nursing and medical skills, so you have the ability to find out what is wrong with a patient and act on that.”

Julie says the process has been an interesting one, growing her skills and knowledge to the point where she felt confident to take the step to nurse practitioner “but now I am starting again on the next learning curve, as a new nurse practitioner in a new role. It will be part of my job to develop that role, to work out what it looks like in practice.”

She says the core of the role is to case manage older people who are frail or have complex conditions, to develop pathways and processes that support older adults in primary care, to promote gerontology nursing and to support the skills of nurses who work with older people in the community.

“There are more than 50 older persons care facilities in the Waikato, and some of them already have access to a nurse practitioner,” she says, “so I need to focus on areas without that support.”

Another area for development is to build relationships with general practitioners, her medical colleagues in those areas. She says overall GPs are becoming much more aware of the benefits of having nurse practitioners they can work alongside, and several GP practices employ nurse practitioners (primary health care). “It will be more a matter of explaining my role as a community-based gerontology nurse practitioner, and how we can help each other.”

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